# EXCEL FOR LIFE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942377114
- **Authorized official:** MARIO JERMAINE JACKSON (DIRECTOR)
- **Authorized official phone:** (252) 205-0381

## Contact information

- **Practice address:** 1730 CAROLINA AVE, WASHINGTON, NC 27889-3315
- **Practice address phone:** (252) 946-4243
- **Practice address fax:** (252) 975-8049
- **Mailing address:** 1730 CAROLINA AVE, WASHINGTON, NC 27889-3315
- **Mailing address phone:** (252) 946-4243
- **Mailing address fax:** (252) 975-8049

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 007044 | NC | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 08/28/2007